JAK inhibitors for the Management of Atopic Dermatitis (AD) - Episode 12
Alexandra K. Golant, MD; Raj J. Chovatiya, MD, PhD; and Eric Simpson, MD, MCR, discuss challenges adolescent and adult patients face with current oral and topical therapies and optimizing disease management.
Linda Stein Gold, MD: This was a great overview on how to practically approach these new treatment options. At this point, we have so much of a challenge getting these patients under control and keeping them under control. You all have so much experience with atopic dermatitis patients who are mild, moderate, and severe. Do you have a particular tip either for getting that patient under control, or maintaining control? Is there anything in particular that you've learned over your experience that you can pass along that is something that's really helped your patients?
Alexandra K. Golant, MD: Focus on having patients recognize and accept that we have no cure for this disease. I don't foresee in the near future that we're going to have a cure for this disease, but that is how lucky we are to be where we are in 2022 with a number of different treatment options and the ability to get patients clearer than they were before, both on the topical and system. I like to set that stage. Patients approach their treatment with a lot of optimism and a lot of hope. For topical patients, trying to get patients on board with, or proactive maintenance where they're not just treating acute flares for a week at a time and stopping then waiting until the next acute flare happens, is very important, especially for the children with atopic dermatitis and getting out of that mentality that we know that there is inflammation that persists between these flares. For systemic patients, trying to get a sense of what drives their disease suffering and personalizing the treatment to that is the concept for the systemic eligible patients who have lived with this disease for so long, sometimes that they cannot imagine their life without the itch or without their AD driving the narrative of their life. Setting the stage that there is a series of events that can make that possible for them has been powerful and important in leading them to the right treatment.
Linda Stein Gold, MD: Our patients underestimate their age significantly because they don't remember what life was like.
Alexandra K. Golant, MD: Yes, exactly.
Linda Stein Gold, MD: Raj, do you have something that you've learned over the course of your career that you can help others to get better control?
Raj J. Chovatiya, MD, PhD: There is a lot of power in the patient voice and what they say about their atopic dermatitis. It's one reason why I'm such a huge fan of numbers, particularly when it comes to patient-reported outcomes. If you can find a way to sneak in a couple of these into your encounters, you can find a way to help keep your patients understanding that you used to be this bad by your own words and now, you're here. Sometimes people are like, “I don't know if I'm better or not,” but they can't argue if it's your own impression, so just ask them, “how severe do you think you are? How well have you done on this therapy and how bad is your itch or pain?” Things that are even outside of an academic setting, where everybody has 3 hours to see a patient like Eric, just simple questions, each one takes a few seconds, and you can get valuable information from the answers. Somebody that may be on the ledge like, “I don't know if this treatment's working,” they're going to feel remotivated and rejuvenated. They might say, “I used to have a 10 out-of-something itch and now I'm down to a 4. You're right, this is working. Let's keep doing it.”
Linda Stein Gold, MD: Keeping it easy… If people had to do an easy score at every visit they would go crazy, but simple things like “how bad is your itching? Did you sleep last night?”
Raj J. Chovatiya, MD, PhD: I love doing the easy scores. In general, easy stuff like that just takes a few seconds to do is so easy to implement. More importantly, you can just look back at that last note and have a good point of comparison.
Linda Stein Gold, MD: Eric, you've had a whole career in atopic dermatitis. Can you whittle it down to maybe a key tip that you can give us a takeaway tip?
Eric Simpson, MD, MCR: The proactive approach is extremely helpful meaning treating normal skin. Once you've cleared it, let's say with topical steroids and using a nonsteroidal to normal skin. Now, we don't have the data in our topical JAK inhibitor on proactive treatment. I would reserve that or document if you're going to use a JAK inhibitor topically for proactive treatment. I do think it will work, but we need to see some studies and some absorption data to safety data, but it is a highly effective approach to keep people clear. On the systemic side, I completely agree with my colleagues. I'd say the only tip is if, when you're trying to make that connection with your patient, I have found that discussing or acknowledging you've probably been told by many physicians and family members to just stop scratching. I would say this is not your fault and to put your guilt aside because you didn't do this to yourself and you can't help it or stop the scratch. I know it feels good, but put that aside; you have a reflex and that's not going to make your disease go away. You did not cause this. When you start talking in those terms, it's amazing how many people carry this idea that they're causing it themselves and just stop scratching it. They're like, “ok, this person is my ally, they get it, and they understand it.” The more you can be a team, the more it helps everything from then on.
Linda Stein Gold, MD: I agree with you and that now you’re on their side, which is wonderful.
Transcript Edited for Clarity